August 8, 2009

In a new posting on her Facebook account, former Gov. Sarah Palin (R-AK) made a dire statement about health care reform -- that it could result in an Obama-created "death panel" killing her infant son with Down Syndrome...

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

She doesn't say that the government will kill disabled (or elderly) persons directly, but that death will occur as a result of the decisions of cost controlling bureaucrats with the power to determine who can receive various treatments. I don't know why "level of productivity in society" is in quotes, nor do I know whether it is the plan to ration care on this basis. Those are actually serious matters, and I'd like to know the answers. What Kleefeld is doing is trying to sweep Palin aside as a big crazy wacko.

Yes, she used a colorful expression "death panel," but it's a good and fair polemical expression if in fact life-saving care will be rationed on this basis. I have found myself saying, in conversation, "I'm afraid Obama is going to kill me." Now, I'm not picturing him or one of his minions coming over to murder me, but I am afraid that as I get older and need expensive care to keep me alive that I will be told I cannot have it, because at my age, in the government's opinion, there's not enough life left in me to be worth the money that I would take from the system that needs to pay for everything.

And here's the end of the Palin post, which I think is cool-headed and manifestly sane:

We must step up and engage in this most crucial debate. Nationalizing our health care system is a point of no return for government interference in the lives of its citizens. If we go down this path, there will be no turning back. Ronald Reagan once wrote, “Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth.” Let’s stop and think and make our voices heard before it’s too late.

"Now, I'm not picturing him or one of his minions coming over to murder me, but I am afraid that as I get older and need expensive care to keep me alive that I will be told I cannot have it, because at my age, in the government's opinion, there's not enough life left in me to be worth the money that I would take from the system that needs to pay for everything."

So you never heard of Medicare? Last time I checked, almost everyone over 65 in this country is on a government sponsored program? And when you are speaking of end of life care, we know you are alluding to the elderly.

So Ann - Are you really this misinformed (that the government already runs health care for the elderly), or you are just trying to create fear amongst the elderly because you have an another agenda?

I think the latter.

if the government really wanted to ration care and choose which old people should die, it would be happening already.

And last time I checked - it was the Republicans who were trying to slash Medicare spending (remember the 1995 government shutdown anyone?)

DTL they are planning on cutting 500 million from medicare to help fund the new plan... where is that gonna come from?

Decreased service (longer wait times) and denial of benefits...

Have you ever read what Rahm's brother has said about elder/disabled care?

“Such an approach accepts a two-tiered health system-some citizens will receive only basic services while others will receive both basic and some discretionary health services… Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”

Ann, this isn't a mere hypothetical fear. If you want to know how the rationing (which is unavoidable - check any French newspaper today for the exploding rationing crisis in France) will be implemented you need to look at the people who have been chosen by Obama to help implement the system.

Dr. Ezekiel Emanuel is the brother of White House Chief of Staff Rahm Emanuel and has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.

Emanuel bluntly admits that the cuts will not be pain-free. "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).

Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).

Emmanuel believes that "communitarianism" should guide decisions on who gets care and knowing this, Obama appointed him to a couple of key advisory positions. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.

He explicitly defends discrimination against older patients: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).

This is horribly monstrous. This is ObamaCare. This is socialized medicine. This is what the assh*les in congress and the assh*le in chief, Obama, thought should be rahm'd through before the August recess with less than 3 weeks of debate.

I hope that the first to be denied necessary care under the new system are those who voted in this monstrous regime.

For "level of productivity in our society" read "ability to pay taxes or likelihood of regaining a tax-paying status." You can't pay taxes, you need support (and therefore are taking money out of the system), why would Barack Obama and his bureaucrats want you to live?

I think that Palin's concern over her baby is very justified. Some liberal commentators have been pretty open about expressing their opinion that Palin should have aborted her baby because it had Downs syndrome. I'm a long way from being the only person who noticed this. It's one thing to support abortion rights, but quite another to see people push the idea that abortion should be mandatory if the baby isn't perfect according to Hyde Park or San Francisco or Upper West Side standards.

“When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.” This may be justified by public opinion, since “broad consensus favours adolescents over very young infants, and young adults over very elderly people.”

And lastly...

“Social Value Allocation” prioritizes specific individuals to enable them to promote other important values, or rewards them for having promoted these values. In view of the multiplicity of reasonable values in society and in view of what is at stake, social value allocation must not legislate socially conventional, mainstream values.”...“Allocators must also avoid directing interventions earmarked for health needs to those not relevant to the health problem at hand, which covertly exacerbates scarcity. For instance, funeral directors might be essential to preserving health in an influenza pandemic, but not during a shortage of intensive-care beds. For instance, former organ donors seem to deserve reciprocity since they make a serious sacrifice and since there is no surplus of organ donors. By contrast, laboratory staff who serve as vaccine production workers do not incur serious risk nor are they irreplaceable, so reciprocity seems less appropriate for them.”

Open your mind and LISTEN to what they are telling you. The clues are all there...

I hope that the first to be denied necessary care under the new system are those who voted in this monstrous regime

Won't happen. The rich are different from you and me (F Scott Fitzgerald)

The proletariat will be judged and graded like eggs at a factory chicken farm. The worthy will receive care and the rest just thrown out. Left to suffer and die....for the greater good of society you know.

Take a pill, while our 'betters' continue to rule every aspect of our lives. They own us now....lock, stock and barrel.

"So you never heard of Medicare? Last time I checked, almost everyone over 65 in this country is on a government sponsored program?"

Bullshit! The government doesn't "sponsor" Medicare.

Medicare is paid for by US citizens via a 1.5% payroll deduction. We pay for it. The government doesn't pay for it.

Medicare currently does not decide who can or cannot be treated or what treatments are given to which patients. Only doctors and hospitals do that with no government interference.

The Democrats want to change that, slowly, over time, so nobody notices.

That's what they're after. They want to decide who gets end-of-life care and who doesn't, so that you vote the right way.

And if you criticize their attempt to do it, you'll go on the government list (snitch@whitehouse.gov) If you show up to protest, their union mobsters will take pictures of you and follow you home and figure out where your kids go to school.

The Obama plan is about giving insurance to those who don't have it, and making it illegal for insurance companies to stop accepting people based on pre-existing conditions, etc.

in other words - its about MORE health care, not less.

Now that INCREASED health care comes with a cost - about $100 billion a year. Is it worth a $100 billion a year to get coverage for the 20% of people under 65 who don't have health care. That's the debate. There's no right or wrong there. Is it worth $100 billion of not? Pure and simple.

When you and Ann and Palin talk about killing down syndrome babies - you are trying to foster an unwarranted fear amongst the broader community. And that's dishonest. And honestly, it's why this blog is becoming unreadable. Posts like this really are an insult to anyone who has even done a cursory readup on the bill. Sorry - but I'll take Ezra Klein over this any day. At least he does his homework.

We have seen several videos recently with Obama, Frank and other prominent Democrats speaking of their preference for single payer healthcare, phasing out private insurance, cutting Medicare costs, etc, followed by the obligatory videos of staffers claiming that the original videos misstate the Democrats' position.

And here's Obama healthcare advisor Ezekiel Emanuel summing up in a 2009 paper who lives and who dies under government healthcare:

When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.

All justified, of course, since:

...broad consensus favours adolescents over very young infants, and young adults over very elderly people.

And of course services will not be "guaranteed" for folks who are "irreversibly prevented from being or becoming participating citizens" -- like Down's Syndrome sufferers perhaps.

Obama has not yet thrown Zeke under the bus.

So I guess it boils down to: Who ya gonna believe, Palin's detractors or your lyin' eyes?

Folks, the fact is that all insurance - public and private - rations health care coverage to make the books balance. Under an HSA, the patient self rations coverage by making a cost benefit analysis of whether a certain treatment is worth the money.

The real debate is who should be making the cost benefit analysis for your medical care - a government bureaucrat, a private insurance bureaucrat or you.

I am in an HSA now because I want to make that decision as much as possible for myself. Because even HSA's have catastrophic health insurance, I do not have total control, but it is better than the alternatives.

I'm having a wild time watching the SEIU and the Democratic congressmen try and pack these townhalls thru the side doors with sympathetic participants, and the crowds of pissed off citizens outside protesting. It would have been one thing if Obama had proposed a period of national discourse (you know, the thing he's supposed to be good at?) around Health Care reform before congress tried to formulate it, but now, after he and the congressional leadership tried to ram it thru with no deliberation. Wow.

It all reminds me of trying to buy a car from a sleazy dealership. Unfortunately , Obama & Co. have created the atmosphere for this debate - now we all get to steep in it. Should be rancorous and fabulously non-productive...

1. Health care is, of course, already "rationed" by private insurers, especially the high-tech variety that can often prolong life despite the existence of ultimately fatal disease. If you are wealthy enough to afford such health care, you will always be able to get it of course, and if you are not that wealthy you will do without -- irrespective of any system reform or public option.

2. What I find offensive about Palin's comment is exactly what revolted me about the TV coverage of the Republican convention -- you know, the "pass the Trig around the stage" scene. To allow your own infant child to be used to score political points: this alone, in my books, renders her morally unfit for public office. And she keeps on doing it, then regularly complains when bloggers take shots at the very children that she has chosen to thrust into the public eye. Absolutely unbelievable!

The America Palin knows is the one that will pay for the ramifications of all her decisions. I want to live longer! Let's have the government pay for it! I want to have unprotected sex when the odds are high(er) that my child will have developmental issues. Let's have the government pay for it! I want a bridge that goes to a nearly uninhabited island! Let's have the government pay for it!

Oh, and I don't want any tax hike to pay for all these things that I want the government to pay for.

Again, they have been telling you what they intend to do, but you are too obtuse to take the next step.

Oh well, DTLs a perfect example of a government run program... education. No research, No extrapolating based on the research, and no ability to form logical conclusions based on the research. Just shallow skimming of the subject, cribbing work done poorly by others and failure to cite supporting documentation.

If anyone cares to look, national healthcare systems like the NHS in the UK employ exactly the type of rationing that Palin describes. Yet we're supposed to believe that Palin is nuts and our benevolent government would never allow such a thing to happen.

And if the gov't doesn't severely restrict treatment options for the most expensive patients, where do all of Obama's magical cost savings come from?

The tests Obama mentions in that youtube clip as "doing nothing to help the patient" so they can be cut out? 90% of them are for the doctor's malpractice insurance protection.

So if Obama REALLY wanted to control healthcare costs, the FIRST thing he'd tackle is medical tort reform. Instead, b/c that lobby (among others) owns him & the Dems, there's nothing being done to rein in malpractice insurance and tort costs.

Of course there will be massive rationing, and of course it will be by age and disease. Non-productive citizens and those lacking political connections will be disfavored.

That's the way it is everywhere else nationalized care has been implemented. Anyone who claims otherwise is lying, and once this has been installed, it will be several generations before, ultimately, it fails because all such schemes are ultimately financially unsustainable Ponzi schemes.

But economic impossibility has never thwarted socialists before, so why would they hesitate now that they can wreck yet another nation?

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil."

The Althouse What-Palin-Really-Meant excuse machine is too lame for words.

I hope she doesn't think there is anyone stupid enough to fall for the Althouse lameness in this post. If so, she's either greatly overestimating her own capacity for compelling BS, or she's greatly underestimating the brain power of folks who don't look to Palin the way junkies look to crack. Or, maybe this post is meant to be a hit for her junkie customers. Vbspurs anywhere?

The America Palin knows is the one that will pay for the ramifications of all her decisions. I want to live longer! Let's have the government pay for it! I want to have unprotected sex when the odds are high(er) that my child will have developmental issues. Let's have the government pay for it!

I hate to say it MadisonMan but you are revealing yourself to be an ignorant asshole.

Your absurd asshole points addressed one by one - Palin wants:1) "to live longer" - and you don't you asshole?2) "let's have the government pay for it" - hey asshole, Palin's point and the republican point generally is to leave healthcare in the realm of the free market (you may be confused, but that means if you want healthcare you fucking pay for it yourself).3) "I want to have unprotected sex when the odds are high(er) that my child will have developmental issues." - Hey asshole, you proposing that the state mandate who can and who cannot have children? Women over 35 better fucking abort any child (after all contraceptions not 100% now is it, or are you advocating forcible sterilization of women over a certain age, you asshole?)4) "Let's have the government pay for it!" See point #2 you asshole.5) "I want a bridge that goes to a nearly uninhabited island! Let's have the government pay for it!" Hey ingorant moonbat, Palin opposed the bridge to nowhere. You freaking idiot!6) "Oh, and I don't want any tax hike to pay for all these things that I want the government to pay for." You mean all of the things that Palin isn't asking the government to pay for laid out above? Are you honestly confused by the conservative/libertarian position that the government should be scaled back and as a result the butcher's bill should be scaled back as well (no new taxes, lower existing taxes)? Are have you suddenly morphed into DTL-lite?

"Welcome to the new Republican party". MadisonMan, welcome to moonbat-ville.

DTL wrote: "Posts like this really are an insult to anyone who has even done a cursory readup on the bill."

The greater insult is from Obots who ask other posters to ignore historical comments by the Congressional proponents of the measures, the known propensities of those proponents and their allies and the measures they take to stifle dissent and slander detractors.

By all means, urge us to swallow (don't get exited Titus) the current representations of our post-racial, reach-across-the aisle, Gitmo-closing, etc., etc., President about his plans for healthcare.

Tell us, DTL, does your comment mean you misunderstood Obama when he spoke to the SEIU about phasing out employer provided healthcare, or Barney Frank when he spoke of this effort as a step toward single payer care?

That could be Obama's health care slogan. Who has done more to make socialized medicine look like a horrible idea than Obama himself? He's the second best thing to having an actual Conservative in the White House.

Just to illustrate what I'm talking about, I was listening to some inner city blacks the other day and heard this:

The idea that health care would be rationed in terms of social productivity is real. It comes into Obama's plans from Ezekiel Emanuel (Rahm's bioethicist brother) and Cass Sunstein who are both advising Obama on health care.

The problem is less whether social productivity should be part of an equation (free markets always do this also, in a de-centralized, individualized way), rather than whether the government--in the form of a public health plan--should be making those decisions in a centralized, five-year-plan sought of way, and then forcing all of us to live by the government's lobbyist and politics driven preferences.

Why is it the Democrats' health care proposal has the odor of a thuggish power grab, and not a wise and well-reasoned public benefit?

I dunno, cause they are trying to ram it without reading it themselves, before the results of all their other"stimulus packages" become known, because we haven't had government run health care for centuries and now it has to be done by August...

"France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics."

Just look at how GREAT universal healthcare is - as if Obama doesn't already have enough ways to bankrupt us....

Yeah Palin is a lightning rod. If she were a moderate or liberal Dem, they'd love her and her up-from-a humble-background story.

Liberal have the same split-personality reaction towards the super-rich. For instance, Soros, Ted Turner, Steven Spielberg, Jon Corzine, Michael Bloomberg, Bill Gates, Waren Buffett are good while Rupert Murdock, Mitt Romney and conservatives like them are evil.

Charles Taylor, an editorial writer at the Washington Post, has a piece opposing the provision in question, but much more sensibly than Palin or Ann.http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html

Of course, I hope everyone here has a living will and an advance healthcare directive as he does. (It makes issues easier, as when a 90+ woman with Alzheimers is diagnosed with pancreatic cancer--what care is appropriate?)

Same as it ever was. To a wingnut though, Palin's moronic jibberish makes perfect sense. Birther teabag retards weren't out protesting insurance companies being one of the few sectors in the economy flourishing, by denying their claims and jacking their premiums triple and quadruple. Only when there is a plan to address it. Unbelievable.

Big Mike: The 'health care reform plan' cannot possibly be intended to offer health insurance only to those able to pay taxes. To do so would cut out 40% or more of all major cities. You know, the ones who already don't pay taxes.

As these represent a major proportion of the Democratic voters, it could never, ever happen, until the rulers really decide that they're on top and can't be overthrown.

We've had 40+ years of liberals telling the elderly and the sick that Republicans were going to take away their social security or Medicare and that they wanted them to die.

And now the worm turns...

Yes, Palin and the Republicans are using (some) scare tactics. Welcome to politics.

But it seems to me that anyone looking at the unfunded obligations of these programs - add some healthcare plan to them - cannot help escape the conclusion that some sort of rationing or scaling back of the programs is going to be needed.

Bigg Katt - what is it about Sarah Palin's child that offends you so? Newsflash - every politician brings his or her children out on stage at the end of a major speech or campaign event. Does the sight of a baby with Downs offend you that much?

Women of childbearing age are already strongly encouraged by the medical profession to screen for Downs and abort Downs children. I don't think it is beyond the realm of possibility that a government run system would eventually refuse to pay for pregnancy expenses associated with the birth of a Downs baby. Downs babies often need expensive heart surgery, etc. Gotta cut costs somewhere ...

DarcyYea my concern is since we don't have a functioning media that can debunk this idiocy to the masses, we won't get any reform and I will still be paying $1000 per month a year from now, or $1500 per month a year later. And so on.

Following up on shady character's comment and avwh's comments about France and their health care costs-

France-

Percentage of national debt compared to GDP

Starting in 1985 France had a national debt equivalent to 37.9% of their GDPIn 1990, the debt rose to 39.5%Beginning in 1995 France has a large increase of their national debt rising to 59.4% of their GDP

Finally in 2000, the annual debt was up to 64.6% of the Gross Domestic Product.

Since 1985 France has had a large decrease in their GDP growth. The national debt and percentage rate compared to the GDP has drastically increased shown in the graph below.

Because of course insurance companies never make life and death decisions regarding coverage. The insurance company is your friend! The whole notion of a pre-existing condition is an evil lie conjured up in Kenya.

And 45 million uninsured does not constitute rationing; they probably want to be uninsured!

Palin made a rhetorical mistake in putting her own Downs baby out as an example. It exposes her to ridicule.

But her point is precisely correct. The only way to reduce cost is to deny care. The denial of care can be a absolute refusal to pay, or a payment to the provider that is so low that it makes the provision of the care unprofitable. Either way the patient loses out. This will be especially true of the elderly, who incur large expenses in the last months of life. Obama has been quite explicit that he intends to reduce this expense.

Ken Johnson, PhRMA's senior vice president, told the Huffington Post the drug lobby has been in touch with the White House the last few days but that he couldn't talk about the specifics of the deal. "It's been a trying 48 hours," he said.

Poor babies! No, don't protestthat.

He did, though, talk about PhRMA's principal goal of the negotiations that led to the deal. "We made it very clear - and again, I'm not talking about the agreement - but we made it very clear that with respect to health care reform, the line in the sand for us was price control," Johnson said.

I bet the line in the sand was price control! If there was real competition they wouldn't be raking in those incredibly easy trillions.

And 45 million uninsured does not constitute rationing; they probably want to be uninsured!

Actually, a large percentage of them do. Many who can afford insurance, especially the young, choose to do without. My 26 year old son let his individual policy lapse and had an appendix problem. I paid his $13,000 plus bill not because I was obligated, but because I was grateful that the hospital had prevented serious illness or perhaps even death for my son. My son's irresponsibility is unfortunately common. I hope he has learned his lesson, as I told him I do not intend to step in for him again.

To AlmaGarret: No, I am not offended in the least by the sight of a Downs' baby -- I thought it was clear that what offends me is Mrs. Palin's repeated use of Trig to score political points. You say that every politician trots their kids onto the stage from time to time, equally to curry favour with the electorate [ah, a good family man/woman] and I concede of course that this is generally true. But how pray tell does that unfortunate reality justify Mrs. Palin's actions in going out of her way to put Trig front and centre every time she thinks that will be to her political advantage, in this case by specifically referencing her infant child by name in the context of what purports to be a purely policy comment? This, to me, crosses a line that should never be crossed, and speaks volumes about Mrs. Palin's character.

Palin made a rhetorical mistake in putting her own Downs baby out as an example. It exposes her to ridicule.

Rhetorical mistake? Palin is a complete nutjob full of paranoia and shrillness. The fact that I'm guessing the typical Palin followers are the same thugs trying to intimidate people at these forums shows how insanely ignorant a minority, but substantial minority, of people have become. Damn facts like the President was born in America or health care reform wasn't intended to begin killing off old people, these mouth-breathers would rather latch on to crazy conspiracy theories and yell at their congressman than engage in any form of intelligible debate. The inmates are definitely trying to run the asylum.

This happened in my lifetime: Jung Chang in her book Wild Swans writes about how the physicians in China were rounded up and sent to farms to spread manure around rice paddies. Their patients suffered and sometimes died from tractable maladies. Jung Chang herself trained as a "barefoot doctor". She was barely able to treat sprains. Nonetheless, the western press uncritically supported this program and hailed it as indeed a great leap forward. You can look it up. Time and Newsweek both ran stories about the breakthroughs in medical care in Red China. If the press could misjudge a murder machine like Mao what are the chances they will diagnose the pathology in Obama's Masscare for the People?

This thread has me shaking my head in bewilderment. Every single one of you who has private insurance has made a choice about what level of health care you will receive, based on your own willingness or ability to pay insurance premiums. A public plan will do exactly the same, of course, in terms of determining a minimum standard of health care for THOSE WHO PRESENTLY CANNOT AFFORD ANY HEALTH COVERAGE AT ALL. So that group of people, quite obviously, will be much better off than they are now. But what about the rest of you, who have chosen a level of coverage that is no doubt, in many cases, higher than what the basic minimum is likely to be under a "public option"? Do you actually believe you will be denied the right to supplement public medical insurance by purchasing additional coverage according to your own ability or willingness to pay -- exactly as you do now? If you do believe that, then all I ask is that you explain where in any of the proposed bills you find language to support your belief.

With limited resources (we only have so many doctor and beds and facilities and capabilities) and an expanding and growing population that needs healthcare (age, illness, new procedures), who will make the decision to cut off the care? Or limit it?

If we have the government increasingly involved, won't it be some "panel" that makes the decision?

Under a government-run health care plan, levels of coverage are limited [use the word "rationed" if you prefer, same concept] but -- and this is the key point -- not on a case-by-case basis, with the decision to treat or not treat being made only when the condition develops. Rather, it is stipulated in advance, what kind of care will be paid for by the public plan, and what will not. You want to know what is covered, just look it up. That way, people who want more coverage and are willing and able to pay for it, can make their own choice about how to top up the public plan.

This has absolutely NOTHING to do with some panel of bureaucrats examining a bunch of files and deciding: OK, patient X can have bypass surgery but patient Y is S.O.L. Can you not see the difference?

Ah BiggKatt, you must be new here. If they're willing to defend the use of a down syndrome baby to paint a completely fictional Orwellian hell that will arise from health care reform, they're not going to "see the difference."

How about we let the government buy from the pharma companies in bulk? That'd save tons of money, but then Obama would be depriving the drug companies of the 26% operating margins that Republican Jesus intended.

The thing that has the popular anger level aroused today is the usually passive public's suddenly found certainty that all that Obama and his con men/women have in mind for them is a classic bait and switch con job. Surprisingly, the monopoly of state power for the good of the people is also the original Marxist bait and switch con job. Once the State has acquired all of the the power, we are switched into slaves. Without a Marxist revolution possible( We still have our Guns), we are told to accept a plan being Rhamed thru that in fact is a classic Standard Oil trust aggressive competition plan. The strongest Company/State simply undercuts all competitors' prices until they slowly fold and sell out to the Company/State for 10 cents on the dollar. Presto-chango, all prices then double and the Company/State's only price competitors are now forever gone. That is the basic offer that the ChiTown Thugocracy has made to us as their only offer we cannot refuse. No wonder the population is suddenly angry. Just as suddenly, Sweet Sarah is again offering to be our point guard that has courage to slam dunk on this ChiTown Thugocracy. IMO These hot days of August are in fact deciding the fate of freedom American Style in this world. So I am very glad the Palin is no longer tied down in Alaskan government procedures. We need her down here right now.

Remember, DBP, the government's "excess costs" are always some other entities "excess profits." You seem to want the government to spend less but all the beneficiaries of the current system to continue making just as much money. Doesn't work that way.

Common sense shows that this administration wants to lock in a leftist government for now and for the future. Leftist Government control of America and her people, Chavez style. This fact is as plain as the nose on our faces, only a fool would deny the fact.

The new system probably would not deny care to such babies because that would be politically untenable. Rather, it would winnow out babies it sees as unfit before they are born by "counseling" (badgering) the expectant mother into having an abortion. Such actions stay tucked away out of public view and we as a society can pretend we don't know it's happening. It's Margaret Sanger's dream come true.

"in many cases, higher than what the basic minimum is likely to be under a "public option"?"

Where do people think money for "public" programs comes from? The giant printing press in the sky? Taxes, taxes and more taxes.

It has been pointed out ad nauseum how a public plan will price out private ones. Thus limiting and/or removing choices we have at present. And necessitating huge tax increases to pay for this "public option". So while premiums may go down, taxes will definitely go up, and we will get less choice.

Also, adding coverage for millions w/o an increase in the number of doctors will lead to shortages. Simple economics.

"I will still be paying $1000 per month a year from now, or $1500 per month a year later. And so on."

People who are worried about the costs of healthcare skyrocketing should be against more govt bureaucracy, not for it. Otherwise you are being inconsistent. The public sector has no incentive for efficiency; only to get bigger. Again simple economics, not ideology.

Non-productive citizens and those lacking political connections will be disfavored.

If only the first half of that statement were true. Who among us is less productive than Congress and government bureaucrats? It's sad that the second half of that statement is allowed to trump the first.

@Darcy: This is the one thing we must demand from our representatives: That any health care bill they pass includes the White House and every member of Congress, and their families (preferably on a trial basis for six months before the bill is passed, so we can see if it works or not). Any intent to pass this bill must be met with a resounding cry of "You first!"

The public sector has no incentive for efficiency; only to get bigger.

This is exactly backwards. Government is run by elected officials, so there's political pressure to see that money isn't wasted (unless you're talking defense spending, but that's another issue). It's corporations with demanding shareholders who are always looking for "growth."

Bigg Katt - Politicians tend to take certain issues personally when they have a personal connection to it. For Sarah Palin, she has made it quite clear from the beginning that she took a special interest in policies affecting children with special needs.

How is that different from Al Gore railing about big tobacco and highlighting his sister's death from cancer?

And now Sarah Palin is a private citizen voicing concerns over an issue which hits home for her. No different from Maria Shriver talking about the need for Alzheimer's research, or Marc Klaas, father of Polly Klaas, supporting Three Strikes legislation.

Better to have an insurance accountant that's paid to deny your claims between you and your doctor than some government bureaucrat!

This is correct (which I realize was not your intention when you posted that statement). As I said in another thread, the insurance company, being a private enterprise, is subject to competition, whereas the government is not. If you decide your insurance company sucks, you can get a new one. It takes quite a bit more effort to get a new government.

Besides, there's at least a perceived higher level of competence in private industry than there is in government, which rarely attracts the "best and brightest;" those with more talent would already be in private industry. Most people who work as government bureaucrats aren't in those jobs because of a profound sense of "service" (unless it's self-service: aiming low by going for an easy, cushy unionized job from which it's almost impossible to be fired); they're there because they weren't good enough to make it in the private sector.

Remember how abortion rights advocates always talk about abortion being a decision "between a woman and her doctor"?

Having the government run our healthcare system and having decisions made about what kind of care we are entitled to based on life expectancy, among other factors, kind of flies in the face of the privacy argument, doesn't it?

They won't have to, they just won't be able to gouge the bejesus out of their biggest customer anymore.Which happens because foreign governments (and poverty) squeeze out their foreign profits, so R&D costs must be recouped in the US.Big Pharma is a fool if they think there won't be price controls down the line if the government is the majority insurer.

In a way, Palin and her sort demanding "free care" for all with the "miracle of private enterprise and free markets" for Freedom Lovers to pay their own way with private charities picking up the slack....and new rounds of tax cuts...

Are as bad as the Katrina scum demanding 'mo money, 'mo houses, 'mo free diapers. And other entitlements.

Medicare alone is 31 trillion in the hole.

China won't loan that. Or the 2 billion a year needed to fund unlimited "free care" for the poor or elderly sitting on moderate to huge nest eggs they don't want touched, but passed on untouched as inheritances without their million dollar terminal illness generating a single bill against their Estate. "Medicare means it's free. All I want! I worked all my life/raised a family..I'm entitled!!"

Rationing is inevitable. Palin's healthy Down's baby is not an issue that may be impacted by future rationing. But may be outside med care as we put more limited school funds into educating the productive than per capita into "special needs children". But a retarded preemie with half a million in neonatal hospital bills and 25-50K in cost per year age 6 months to 3 years??If people claim they LOVE LIFE so much..they may have to show it by signing their home and a portion of the money they earn for the next 25-30 years over to medical bill collectors. Or asking fellow pro-life at any cost!! people to donate their homes, savings.

And inevitable rationing may mean an end to "asset protection" in the elderly. (An end to ranting seniors waving their Medicare cards and demanding..."I have two homes, a business, and 800,000 dollars in savings...I demand you government protect that for my heirs and force taxpayers to pay for the best care I can get in old age!!)

Its just all in the cold, hard numbers.You can't continue the bandrupt system we have. We have to get our costs lowered 50% or so and in line with the Euros and Asian competition.Talk about inviolate "rights" of Alzheimers elderly, the "right" of those on welfare, in prison, here illegally to get the best care imaginable...but at the end of the day, if costs aren't contained and care rationed..and the money isn't there...the hospital is forced to close, the doctor will not accept government plan patients, the family with modest means and a Mom paralyzed by stroke are told "Good luck" by the 20 facilities they call unless they sign over her house...

What I find offensive about Palin's comment is exactly what revolted me about the TV coverage of the Republican convention -- you know, the "pass the Trig around the stage" scene.

Everytime I see some version of this comment, I wonder about the author - not the subject of his comments.

"Revolted"?

Are you serious?

I work in an office that serves the public so babies are often there. THE STAFF is likely to share the baby more than the Palin family did on that night.

Why? First, WE all happen to like babies.

Second, babies don't always shut up when told to like our President would prefer that the rest of us do. They have their own timetable and are soothed when they feel soothed.

"Revolted"? You need to get out more ....

... much like those who are claiming that the crowds at the town halls are ALL paid by the insurance company Nazis. The comments from Democratic politicians over the last few days have made me wonder if they ever had coffee at McDonalds before noon. Most Town Hall crowds that I have seen on television look like they just came from the senior special at McDonalds.

Thank goodness for the sane Democratic representatives who have publicly refused to spout the part line about the crowds at those town hall. They are the ones who look the sanest.

And BigKatt, my insurance company doesn't ration care, we purchase care. My policy has a $2 million lifetime limit. That was my choice and decision.

Blogger Kev said...

Better to have an insurance accountant that's paid to deny your claims between you and your doctor than some government bureaucrat! ... This is correct (which I realize was not your intention when you posted that statement). As I said in another thread, the insurance company, being a private enterprise, is subject to competition, whereas the government is not. If you decide your insurance company sucks, you can get a new one. It takes quite a bit more effort to get a new government.

I think a very big overlooked point is the effect of ERISA (Employee Retirement Income Security Act). Because of ERISA, if you get insurance through your work, you don’t have insurance, if by that you mean an enforceable contract that the insurer will cover what they say they will. If an insurer denies a claim, ERISA (1) limits remedies such that the insurer has no incentive whatever to live up to its contractual promises; (2) deprives you of a right to trial by jury and quite often profoundly limits discovery; (3) imposes a standard of proof on you in just about every case which means if you prove the insurer was wrong, you still lose. You have to prove they were ridiculously, absurdly wrong. There are lots of other bad effects, but the bottom line is that if you get your insurance through your work, you don’t have insurance – just a piece of paper saying some insurer will cover your medical care if it feels like it. And if it wrongfully denies care, there’s precious little you can do about it.

So madawaskan, you are going to hold a governmental plan accountable at least as much as you get to hold a private plan accountable now. Pat CA, the care you purchased may not turn out to be the care you end up getting, because your ability to enforce the promises in the policy is very very compromised (not applicable if you purchased your policy independently of your work, but that’s a distinct minority of cases). And Kev, once you are sick of course, and find out your insurer is screwing you over, you’re not going to be able to change insurers, and enforcing the policy you have is, again, swimming upstream.

The present system provides insurers with significant incentives to commit bad acts as an ongoing business practice – doing so increases shareholder value after all. That needs to change most of all.

I called Specter and Sestak's office. Each had a high school intern answering the phone and neither would tell me how Spectr or Sestak will vote even though Sestak has been a big supporter of this so-called reform.

One of the interns said he himself "wants to help people" that is why he is interning. The kid is already brainwashed.

This is not about efficiency. If it was about efficiency, the debate would be over and the Free Market types at Reason Magazine would be writing the bill.

This is a grab for power and money by the Looter Class that runs the Democratic Party. Period. Don't bullshit the rest of us about the virtue of their aims. Obama and his crowd want power and control, and they mean to obtain said power and control over people's lives by siezing the commanding heights (Lenin's term) of people's means to stay alive: the Health Care system.

Palin gets to the nub of the matter by getting that central fact: that this is about people's liberty from government, not about cost.

There are other ways to reform the Health Care system to make it more responsive and less costly to consumers, but stoking Obama's ambitions and putting us in greater debt to the Chinese Mandarinate is not the way to do it.

Lastly, there will develop a two-tier health care system under Obama's National Socialism: one for the wealthy and politically connected, and one for the working class. Democrat and Republican politicians and the wealthy and well connected will get on demand health care.

The rest of the country will get rationing.

That is what WILL HAPPEN. Period. Don't try to bullshit your way out of that box, because no one here believes otherwise.

Obama and his people stand in favor of the Ruling Class. That is all they stand for. It is ironic that a Left Wing Regime is trying to reinforce and fortify the privileges of a new Nomenklatura. But then, that's what the Left always does when it gets power.

As I read the bill at least as much redress. Section 132 of the bill provides: (c) EXTERNAL REVIEW PROCESS.—5 (1) IN GENERAL.—The Commissioner shall establish an external review process (including procedures for expedited reviews of urgent claims) that provides for an impartial, independent, and de novo review of denied claims under this division.

That does not sound like access to the courts, and I am unable to find in the bill anything specifically addressing that. But what is important here is the phrase “impartial, independent, and de novo” – that means the external review procedure will reverse a decision if it is wrong. You will no longer have to prove a claim denial was an “abuse of discretion” or was “arbitrary and capricious,” which is what you have to do now. Just that it was incorrect.

I would not find this adequate as an enforcement mechanism if we were writing on a blank slate, and do not think it is adequate going forward. But it is at least as good as the inadequate system we already have. And it does not depend on the tender mercies of congressional interns.

I'm in the military health care system-I don't want to get too much into the damn details of it but let's just say that I am under the illusion that the government doesn't do it that great and that whatever you have out there has got to be by definition-better.

And, they weed out the unhealthy from the get go so the pool of people they serve isn't that bad off to begin with-yet still there are some places where...

You are willing to put a large part of your life and your destiny into the hands of govt "leaders" drones like Joe Biden, Barack Obama, George Bush, Ted Kennedy,Mitt Romney, or any recent mayor of Philadelphia, etc.

These are the same people who have "given away the store" with respect to govt employee pensions and benefits.

These are the same people who have caused govt spending to increase by 7-10% per year for the last 20 years.

Have the incomes of the average American increased at the same rate? The answer is no. So why should the cost of govt balloon at such a ridiculous rate?

You up the cost to them to hire with an increase in minimum wage, the added cost of universal health care for those that they employ, and when the pool of employed dwindles you UP the taxes of those left surviving in the Public Sector.

What are you going to have left of the economy-the free market one which is 70% dependent on private consumer spending?

You are going to have more and more people if not employed by the public sector, damn dependent on the government.

It will be a fundamental change of America, and it will come at all kinds of costs-unintended and then some.

You know who benefits from killing health care reform? Insurance companies. That's about it. Thankfully there's this thing called the "conservative movement" that's ready-built to defend their financial interest, because you poor chumps don't know any better.

David said... Palin made a rhetorical mistake in putting her own Downs baby out as an example. It exposes her to ridicule.

But her point is precisely correct. The only way to reduce cost is to deny care.

Incorrect. The Germans, French, Japanese have longer lifespans than us, and their costs are 50% lower. What they have done is drive efficiency into their systems, not from it...as is the US, UK, and somewhat Canadian model.The best and most efficient healthcare providers make more money in the Japanese system..The rate of medical and pharaceutical innovation matches or exceeds the US model, per capita in France, Japan, Taiwan, Germany, Scandanavia. Nurses and techs do many of the functions the AMA has demanded be reserved in the US only for the high-paid MD Guild to do.We have had "no-doctor" systems that worked pretty well for 95% of medical needs in remote villages, and at distant military bases and aboard warships. We empowered practitioners such as a Army medic, a Montana Veternarian, a Sioux woman with a nursing degree - to dispense medicines, do emergency surgery, treat 95% of ailments they were presented with. Sometimes with phone, radio, telegraph, now Internet backup to consult higher-trained professionals in their field..

Americans used to be smarter about these things.

We saw a well-developed English textile industry or German missile program - the first thing that cme to mind was how to beg, borrow, or steal it to create an American system...not reinvent it.

For now, we sit with various ideologues telling us that community organizers can create a great system from scratch, they will not settle for anything less than a doctor treating them for a high fever, that we should listen to the voices of wisdom at the AMA and Big Pharma, or that nothing needs to be fixed because what we have is actually "the envy of the world!" with money no concern, and those saying it its all about "Freedom for Freedom Lovers!!"

Nowhere are we talking about how well the French, German and Japanese systems work - only the deficiencies of the UK and Canada.

Nowhere are we engaging in an honest philosophical argument about how to square our incompatable beliefs that government must provide those in dire need care, but otherwise not meddle in a collapsing system, and not raise taxes on us, and seniors don't have to pay a penny out of pocket...

I'm in the military health care system-I don't want to get too much into the damn details of it but let's just say that I am under the illusion that the government doesn't do it that great and that whatever you have out there has got to be by definition-better.

It may not be an illusion at all; I certainly do not think I am in a position to say. I would just say when it comes to redress for getting screwed on your health claims the current system is itself an illusion. You get screwed over, go to court, and find yourself in a Bizzaro-world system where insurance companies are treated like they are Learned Hand, and even if you get the decision reversed you end up with no recourse for the effects on your life the bad decision had. I practice mainly in the disability insurance part of ERISA-world, but the same principles apply. I’ve had clients driven into bankruptcy, lose their homes, you name it, because their disability benefits were denied on the flimsiest of all possible bases. And ERISA provides nothing - absolutely nothing – by way of redress for that. If I can prove an “abuse of discretion,” I can get them the benefits they were supposed to have received years earlier, when it might have done them some good. But the bankrupt finances, lost home, ruined life? Nothing for that.

I do not pretend the enforcement mechanisms we are likely to have under a new system will be adequate. I just think what we have now stinks, such that the numbers of the uninsured should be vastly increased to include all the people who get insurance through their employment, because they don’t have "insurance" either – they only think they do.

And BTW, re your military health care – if anyone deserves adequate care and meaningful enforcement of their rights you and your fellow veterans do. So please do not think I would not be in your corner too.

Here's a senior citizen who will no doubt be declared unsuitable for treatment due to poor lifestyle choices and advanced age.

While the above is intended as humor, it is chilling when you consider how many millions of us will be vulnerable to govt whim.

When are you expendable? What if it is tomorrow?

I have a friend who was T-boned in an intersection by a red-light runner and made a paraplegic at age 53. As a successful patent attorney he had excellent medical and auto insurance and the financial wherewithal to recover and resume his life after a few years of treatment, therapy and training. He competes in wheelchair athletics, has a happy family life and is one of the most vibrant beings you'll meet.

However he no longer practices patent law, he became an advocate for the disabled and is very concerned about rationing and denial of treatment. One already requires an attorney to obtain disabled benefits and state budget cuts are decimating services as is.

All of us are just one traffic intersection, test result, slip or fall away from being disabled or diagnosed with a chronic disease and hopefully all of us will one day be elderly.

Dr. Linus Pauling was still researching in his 90's, Julia Child spreading her vast knowledge and love of cuisine into her late 80's, and Ana Mary Robinson "Grandma" Moses didn't begin to paint until she was in her 70's. It's not just the arts or science but the accumulated knowledge of millions of professionals, trades & craftsmen, inventors and entrepreneurs; the people who make, build and invent the things that create our comfortable daily lives. Would we be destroying the living knowledge equivalent of the ancient's Library of Alexandria?

Politics aside, these and other concerns should be answered to our satisfaction. We need to back the reform truck up and address the current shortcomings. You do not demolish your entire house to repair a leaky pipe in the kitchen, so why are we destroying what works to address what doesn't?

3. 150 dollars goes to high paid professionals charging fees for services other countries let nurses, store owners, well-trained techs - do. Or accounting for US doctors, nursing home owners, specialists, hospital administrators making 45-70% more than counterparts in other countries (who have no shortage of people applying, unless they are "brain-drained" to the USA or wealthy Arab nations..)

4.70 dollars are for lawsuits only allowed in the USA.

5. 140 in drug costs in America, while the same burden in other countries is 70-90 dollars.

You are willing to put a large part of your life and your destiny into the hands of govt "leaders" drones like Joe Biden, Barack Obama, George Bush, Ted Kennedy,Mitt Romney, or any recent mayor of Philadelphia, etc.

Respectfully we are just talking past each other because we distrust different people more. If you believe government is always necessarily corrupt then of course you will oppose any plan which in any way involves the government. I will not attempt to talk you out of that.

But I think, based on experience on both sides (I represented insurers for many years) that the insurance industry is more corrupt. In truth I think a lot of them belong behind bars. If you suggest maybe we should change the law so that there is a possible remedy if you prove outright fraud on their part, they’ll argue then they’ll have to increase premiums and insurance will not be affordable. They can’t provide their service for a reasonable price unless they get immunity from civil liability for ... fraud. What the hell kind of an industry is that?

I'm in the military health care systemI was in the 70's as a dependent, when budgets were tight, active duty salaries didn't keep up with inflation, and no draft to sign up good doctors and corpsmen. We were going to Bethesda, the best the Navy offered, but I would not wish to repeat the experience. At least I missed the boy-molesting cardiologist, barely.

OTOH, 4 private doctors couldn't figure out that my cats were giving me severe indigestion. I didn't either until after they'd died years later.

Ya I'm sorry for using the "damn details" phrase but just thinking about it all-really pisses me off.

And, hell I hope to god that it's erratic and it isn't as bad everywhere for everyone, all I know is I was left with the impression that my gawd if I come down with something really bad these terds of the bass are going to kill me..

Did you see this for France-

Finally in 2000, the annual debt was up to 64.6% of the Gross Domestic Product.which leads me back to National Defense.

Obama hasn't lessened the commitments, he's upped it in Afghanistan by 30,000....

France doesn't even have near that obligation but look how under water they became.

Health care at the cost of National Defense -I don't think Liberals mind that scenario at all.

Mrs. Palin might have more credibility if she hadn't failed miserably at overseeing the care of the elderly and disabled during her governorship. From the July 14 issue of the Anchorage Daily News:

"State programs intended to help disabled and elderly Alaskans with daily life -- taking a bath, eating dinner, getting to the bathroom -- are so poorly managed, the state cannot assure the health and well-being of the people they are supposed to serve, a new federal review found.

"The situation is so bad the federal government has forbidden the state to sign up new people until the state makes necessary improvements.

"No other state in the nation is under such a moratorium, according to a spokeswoman for the federal Centers for Medicare & Medicaid Services....

"A particularly alarming finding concerns deaths of adults in the programs. In one 2 1/2 year stretch, 227 adults already getting services died while waiting for a nurse to reassess their needs. Another 27 died waiting for their initial assessment, to see if they qualified for help."

What nonsense. The provision Palin's spokesperson identified to Jake Tapper as the "death panel" provision, sec. 1233 of H.R. 3200, doesn't mention any panels and doesn't say anything about rationing.

My own quick look at the rest of the bill did find a federal “Health Benefits Advisory Committee” that would help the Federal Government establish minimum standards for an “essential benefits package” for private health plans. That’s in sections 122-124 of the House Democrats’ bill. While plans wouldn’t have any legal reason not to offer a better package of benefits than the “essential” package, it’s possible that as a matter of economics, not of government regulation, some plans would decide not to cover more than the minimum. But that’s a far cry from there being a federal “death panel” that rations treatments according to anyone’s “level of productivity.”

People ought to check their facts before trying to scare other people about health insurance reform. That includes you.

It's difficult to take someone seriously who says things like"I want a bridge that goes to a nearly uninhabited island! Let's have the government pay for it!"

Describing Gravina Island as "nearly uninhabited" completely ignores the fact that it is the home of Ketchikan International Airport, which is currently reachable from Ketchikan only via a seven-minute ferry ride.

Whether that bridge would have better served Ketchikan residents and visitors better than the ferry is a legitimate question. Your mis-characterization, dropping out essential facts like that, is dishonest.

I have found myself saying, in conversation, "I'm afraid Obama is going to kill me." Now, I'm not picturing him or one of his minions coming over to murder me, but I am afraid that as I get older and need expensive care to keep me alive that I will be told I cannot have it, because at my age, in the government's opinion, there's not enough life left in me to be worth the money that I would take from the system that needs to pay for everything."

Sorry, but that's a ridiculous thing to say in conversation. Comments like that feed the sort of paranoid fury that we're seeing these days from (and I'll be charitable here) some elements of the right. By the way, what makes you think that health insurance companies don't or won't make cost-benefit analyses of what level and type of health care should be provided to you?

Doyle wrote: Hombre: Is it your contention that there's no disincentive for politicians to waste money?

It is my contention that there is no effective disincentive for politicians to waste money, particularly at the federal level and my evidence is that politicians do, in fact, waste money at prodigious levels. Today's example is airplanes and travel.

However, the most glaring absurdity of your claim is that "government is run by elected officials."

Government is run by bureaucrats. The average member of Congress has no clue about the level of waste or how to stop it and neither does the President.

garage mahal says: I bet the line in the sand was price control! If there was real competition they wouldn't be raking in those incredibly easy trillions.

Actually, I wouldn't be surprised to see some sort of price controls come out of the reform package - namely, price controls that are more favorable to the insurance companies than the doctors. In other words, cost control via a regulatory system arising from a balance of interests between the government and the insurance business. And once again, medical doctors will be played for pawns and chumps by the insurance companies, but will politically back them up anyway.

"You" is Ann Althouse, and the two passages in her post that are most objectionable are,

"I don't know why 'level of productivity in society' [in Palin's Facebook post] is in quotes, nor do I know whether it is the plan to ration care on this basis. Those are actually serious matters, and I'd like to know the answers."

and

“Yes, she used a colorful expression ‘death panel,’ but it's a good and fair polemical expression if in fact life-saving care will be rationed on this basis."

Former Governor Palin’s “colorful expression” describes something that is not in the House bill section that Palin’s spokesperson mentioned to Jake Tapper. Ms. Althouse had no business praising “a good and fair polemical expression” without making some effort to find out if anything in the bill actually rations life-saving care.

It use to be that everyone, rich or poor had the same access to the same health care. The king got sick? Leeches! A peasant got sick? Leeches!

But now that there is [i]real science[/i] in medicine it's really expensive. In America the wife of an insurance company executive can blow 60,000 dollars on new tits and a face lift, but her poor cleaning lady, or their kids after-school tutor will die of breast cancer because she can't afford the chemo-therapy. Or, if she's lucky she'll get the therapy and masectomy and for the rest of her life will be an indentured servant to whatever hostipal she will have to pay back.

Leeches don't cut it any longer. The discrepancy between the rich (some who got rich by denying health insurance claims to others) and the poor is in a way wonderful--via the advances in technology; but in other ways a sad state of affairs.

Those supporting the bill have no business saying the bill *won't* ration life-saving care or other medical care as a natural result of the change in policy.

Since the supposed savings in unnecessary health care are supposed to make all the difference, there WILL be a great deal of denied care, everyone supporting the reform is *explicitly* counting on it.

This is so profoundly disengenious, I don't know where to start. Life insurance companies already do this. Read any of the millions of stories, on how life insurance companies get to decide who and how care is received. So if you actually cared about the denial of care, you sure wouldn't be supporting the status quo that allows insurance companies to do exactly what they are currently doing.

Finland has universal health care. When I was teaching there I got a kidney stone. I spent eight hours in a waiting room until a doctor's assistant came in and diagnosed me (I had already cracked a tooth from gritting my teeth). Instead of an expensive operation, I was given an aspirin, and told to come back in a week after it had passed.

In America, I also had a kidney stone. I had a 12 thousand dollar operation to put a stent in, which enlarged my urethra so that the stone could pass. I was teaching at a community college, so my health care picked up the tab. I paid 80 dollars, and could go back to work in the morning.

This happened in Oregon. I think that euthanasia is probably even cheaper than aspirin, and if the Obama-ites find out I'm against them, they would only be too happy to kill me, and with it, to kill my vote, and to save money to boot.

There may well be two lines in the future: those who are with us, who get excellent care, and those who are against us, who will be euthenized.

At least that's how things went in Russia under STalin, and I should think that that should be the real model for understanding how this system is going to play out.

Any system will ration health care, the question is who or what will do the rationing. Currently it is a hodge-podge of price controls (Medicare) insurance trying to balance profit and attracting customers and individuals weighing costs against benefits. The current bill will set in motion the ultimate end of a nationalized system.

In economics, rationing is done along a spectrum with communism at one end and capitalism at the other end. In Communism, the central authority determines the price and quantity of every thing and service to be produced. It always ends with shortages or surpluses and in the end poverty for all (except the elites). With capitalism, the interplay of profit-motive with supply and demand leads to efficient allocation of resources and thriving economies.

I think it is not debatable which system leads to greater prosperity and freedom. So why are we trying to move our health care system in the direction of central control?

Wow, alot of angst over what Dr. Emmanuel wrote. Perhaps if folks had actually read the article in Lancet from which the quotes came, there could have been a constructive discussion.

You do realize that the quote comes from an article about the ethical challenges that arise when difficult decisions have to made for “very scarce” medical treatments. For example, a situation where only one healthy liver is available for transplanting and ten people desperately need the transplant. The article is NOT about health care availability or medical treatments in general. I'd guess that nobody using those quotes had any idea of the context.

It is astonishing how right-wingers took a reasonable discussion over ethics and twisted so horribly into "just let grandma die."

JimInMinn...We are mostly moderates here. But this disussion is about the rationing of medical care. And Obama does not care enough about us to admit the truth and to discuss that with anyone. He just wants to lie and sneak in his rationing plan on a pretense that nothing will change. So why would you willingly go along with that intentional con job? The world awaits your rational answer. If the answer is that you are suicidal, then call the suicide help line immediately. If not, then you may be a very easy man to fool.

The Monster - Describing Gravina Island as "nearly uninhabited" completely ignores the fact that it is the home of Ketchikan International Airport, which is currently reachable from Ketchikan only via a seven-minute ferry ride.

Ketchikan is a small town with a declining population. Down from 9,000 in 1990 to 7200 now. Across the Tongass Narrows, Gravina Island IS mostly uninhabited. The only reason the airport is called "international" is that previous pork went to build that place with long runways for possible military logistics use..

Otherwise, we are talking about a small backwater buttfuck town and a bridge-building subsidy that would amount to over 30,000 per resident and possibly halt the towns decline. (And enrich the good old boys who had invested in Gravin Island real estate).

I guess they'll just have to put up with that awful 7-minute ferry ride, despite the best efforts of Ted Stevens and the Goddess of the Religious Right and Know-nothings to keep that pork from Lower 48 taxpayers earmarked for Alaska....

================== Synova said... "...what revolted me about the TV coverage of the Republican convention -- you know, the "pass the Trig around the stage" scene."

Palin should consider Rosemary Kennedy as a template for the proper way to deal with her political career and her son Trig.

No?-------------Agree with both statements, actually.Trig was passed around like a pro-life trophy to thrill the RTLrs like Terri Schiavo's "fight" once did.And used further by Palin as a sympathy/support getting tool in her speeches and actions later on.

Total drug spending from $0–$295 Deductible is out-of-pocket No Medicare coverage of costs

$295–$2,700 25% out-of-pocket 75% covered by Medicare

$2,700-$6,154 - $896.25-$4,350.25 All costs are out-of-pocket No Medicare coverage

over $6,154 5% out-of-pocket 95% covered by Medicare

This is why retailers such as Wal-Mart are selling $4.00 a month or $10 for 90 day generics like hot cakes.

That's not the worst of it, Part A (hospital) has a 20% co-pay and Part B (doctors, tests) co-pay is 30% not covered by Medicare. So a senior hospitalized with a broken hip would only have 50% of their cost covered by Medicare, not including drugs outside the hospital.

This is why the AARP is the largest broker of Medi-gap and Advantage plans (Obamacare will eliminate Advantage plans). Advantage plans are like an HMO, no choice of doctors, etc.) Medi-Gap policies are PPO, a network of providers from which to chose.

There is also a monthly Part B payment deducted from Social Security benefits. In 2009 it begins at $96.94 and rises proportionally to benefits.

Many, many retired working people, especially older seniors, receive $600 -$800 a month and $96.00 is a huge portion out of their meager stipend and co-pays are impossible.

In an effort to control Medicare shortfalls, Congress decided to cancel or reduce COLA for SS recipients. However, as usual, the govt blew it.

Under current law, when the Medicare Part B premium increases more than the amount of a person’s Social Security COLA, the government is required to adjust the Medicare premium so that the person’s Social Security check is not reduced from one year to the next.

According to the Congressional Budget Office’s (CBO) 2009 annual Budget and Economic Outlook, the Consumer Price Index (CPI) is expected to drop because of easing gasoline and other prices, a characteristic of recessions. By the third quarter, when the government determines the annual COLA payable January 1, 2010, the CPI may be close to, or at, zero, the CBO said. And according to the 12 month CPI data through December 2008, the index used to determine COLAs isn’t just zero, it’s minus 0.5%.

Should inflation come down to zero, or even near zero, and Medicare Part B premiums increase even modestly, the federal government could be on the hook for potentially billions in unanticipated Medicare Part B premium costs that normally are automatically deducted from beneficiaries’ Social Security checks.

There will be no COLA for 2010.

This is how badly Congress is managing Medicare, so what makes you think they can handle your medical care any better?

simply, why?in this country would we not insure all Americans?why would we not help the sick?those that would not consider it have possibly not known anyone who has been gravely ill and not had insurance. this greatest country in the world bullshit is just that, b.s.

I guess they'll just have to put up with that awful 7-minute ferry ride, despite the best efforts of Ted Stevens and the Goddess of the Religious Right and Know-nothings to keep that pork from Lower 48 taxpayers earmarked for Alaska....

The cost of the bridge WAS given to Alaska even though Alaska didn't build the bridge.

Now what party was in control of both houses of Congress in 2007?

It starts with a "D" and ends with "emocrat".

Meanwhile, the John C. Murtha airport, which has received $200 million in federal subsidies and has three flights per day, is named for what Democratic Representative?

simply, why?in this country would we not insure all Americans?why would we not help the sick?

Let's make a law that forces car insurance to covers oil changes and gas, and see how expensive it gets. When large numbers of people can't afford it, let's have the government pay for it. They can then borrow some more trillions from the Chinese, or they can raise taxes on everyone.

The insurance will then be too expensive for a lot more people. Let's force the insurance companies to lower the prices to what the government charges. Then they can go broke and the government can figure out how to pay for it, by raising more taxes or borrowing more money.

Not insuring everyone is not the same as not helping the sick, except in the limp brain of liberals. That is a false argument, and any time spent in an ER would prove that - the places are packed with uninsured illegal aliens who get medical care at no cost to themselves. So, that portion of the system is not broken, it is just paid for by others.

JiminMinn wrote: I'd guess that nobody using those [Emanuel] quotes had any idea of the context.

The problem with hanging around with Lefties all the time is you begin to think everyone is as dumb as they are.

Here's the context from which I quoted: We recommend an alternative system—thecomplete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporatesprognosis, save the most lives, lottery, and instrumental value principles.

Emanuel is an advisor to The One. What is it about the role of "advisor" or the meaning of "recommend" that escapes you?

The Obama plan is about giving insurance to those who don't have it, and making it illegal for insurance companies to stop accepting people based on pre-existing conditions, etc.

Out of curiosity, DTL, if you cannot be refused coverage due to a pre-existing condition --- why would anybody pay for insurance at all except for the brief time when they're in the hospital?

So madawaskan, you are going to hold a governmental plan accountable at least as much as you get to hold a private plan accountable now.

Rich, given how the Congresspeople are behaving about their own constituents questioning this bill, you seem awfully optimistic here.

You know who benefits from killing health care reform? Insurance companies. That's about it. Thankfully there's this thing called the "conservative movement" that's ready-built to defend their financial interest, because you poor chumps don't know any better.

Ironic, Doyle, that insurance companies are on board with Obamacare, isn't it?

But I think, based on experience on both sides (I represented insurers for many years) that the insurance industry is more corrupt. In truth I think a lot of them belong behind bars.

Makes you wonder why no state has removed an insurance company's license to sell policies in their state, doesn't it Rich?

IM: "So if you actually cared about the denial of care, you sure wouldn't be supporting the status quo that allows insurance companies to do exactly what they are currently doing."

At what point have I said anything about supporting the status quo?

If we should talk about disingenuity, how about we talk about that?

That's the really big lie isn't it?

This idea that anyone who doesn't think this is grand or at the very least a step in the right direction (instead of the very wrong direction) wants the status quo?

Now, if given a choice with only two options, Obama's plan or the status quo, I might prefer our present system as the lesser of two evils. True enough. But that is not at all the same as viewing the status quo as the best possible option.

"why would we not help the sick?"

And this heartfelt plea is the second big lie.

The most essential part of *helping* people is doing something that will actually WORK, will make things better and will HELP them.

There is a reason that we only ever EVER hear the phrases "his heart was in the right place" or "she meant well" when something excessively dreadful has happened.

It is not enough to have compassion or to prove that we have compassion or to let ourselves be shamed by being accused of being heartless and so push through something that makes US feel good about ourselves and how much we aren't like those mean people if the vehicle of our virtue and minor godhood is harmful.

Better to do something than nothing? No, it most often is not. If our attempts to show how much we care for the downtrodden trods them farther down, we are not GOOD people, no matter our motivation, no matter where our hearts are... we are evil and we are accountable for the hardship our pleas for compassion cause.

JimInMinn: "It is astonishing how right-wingers took a reasonable discussion over ethics and twisted so horribly into "just let grandma die."

There is *always* scarcity.

Many of us believe very strongly that scarcity for medical care that *doesn't* rely on someone dying in a car accident and donating their organs will increase in proportion to the extent that government is involved in medical care.

Your argument assumes that there is not scarcity other than in the context of situations analogous to being on a heart transplant list.

The most obvious area of scarcity will be funds. We're told that there will be efficiencies by eliminating treatments deemed unlikely to succeed or cure a patient, that counselors will help old people make better choices, that people *will* be encouraged to prefer less expensive treatments. Take a pill.

"'So madawaskan, you are going to hold a governmental plan accountable at least as much as you get to hold a private plan accountable now.'

Rich, given how the Congresspeople are behaving about their own constituents questioning this bill, you seem awfully optimistic here."

It doesn’t feel too optimistic to me. “At least as much as you get to hold a private plan accountable now” is hardly at all.

"'But I think, based on experience on both sides (I represented insurers for many years) that the insurance industry is more corrupt. In truth I think a lot of them belong behind bars.'

Makes you wonder why no state has removed an insurance company's license to sell policies in their state, doesn't it Rich?"

You are correct that my opinion about who belongs behind bars does not carry the force of law. Indeed, leaving aside very real questions about how many insurance regulators are lackeys of the industry, what is going on is in fact legal. That’s the problem.

What do you think of the idea that insurance companies should not get a pass when they commit fraud, as is presently the case? What do you think of the idea that, if you take them to court and prove they were wrong to deny your claim, you should win (instead of having to prove they were “arbitrary and capricious”)? I do not think you have to have as low an opinion of them as I have to believe the system needs some serious tweaking.

I am sure that others must have said this. But here goes again. How can we do nothing? People now simply have no insurance Period!!! Is that not like a "death panel" only in this case, "death panel by default". If you turn a blind eye, then who can hold you responsible? Sarah Palin's son would be taken care of no matter what. My concern is for those downs children born today that are not insured even though the parents are working. What will happen to them has nothing to do with a panel. It has to do with "doing nothing!"

"She doesn't say that the government will kill disabled (or elderly) persons directly, but that death will occur as a result of the decisions of cost controlling bureaucrats who with the power to determine who can receive various treatments."

Doyle amazes me. Government has no disincentive to waste money? Are you truly that ignorant?

I worked for the feds, worked as a consultant for the feds and have several friends now who work as consultants for the feds. One thing that is for sure is that when you get close to the end of the fiscal year your supervisors tell you to use up all the funds in the budget or you will not get enough to run the next year. They don't care what you spend them on; just spend them. I am talking about at the DOJ, the Pentagon, NSA, FBI, Social Security, Census, Dept of State, Treasury Dept. All of them where I have friends working and they all have that same policy. Does that sound like a disincentive to waste money to you?

"California's Medicaid Reform Act of 1982 increased competition among hospitals in urban areas, with legislation which allowed direction of patients to more efficient providers via selective contracting. This slowed the average rate of hospital cost inflation, and saved the state billions of dollars. The substantial short-term savings have been documented in empirical research, but little attention has been paid to the longer-term effects of the reforms. We find that Medicaid contracts were awarded to more efficient hospitals. The distributional effects post-reform resulted in efficiency gains for most hospitals, but costs escalated for over half of the public hospitals in the sample, as their uncompensated care burdens rose. Public hospitals continued to fail during the period, leaving over half of California's counties without a county hospital by 1990."

Here's how the SF Bay Area, home to both of California's senators and the Speaker of the House fared with prostrate cancer detection and treatment after the reform act:

Contra Costa County. The county health facility has undergone a series of cutbacks. Uninsured individuals are often required to pay for treatment in advance of receiving services and men who earn between 101% and 300% of Federal Poverty Level (FPL) are required to pay a partnership fee for treatment as well as cover the cost of their medications, which may exceed $1,000 per month.

Alameda County. Alameda County has one of the largest African American populations in the State. African American men are 3 times more likely to be diagnosed with prostate cancer than white men. The Highland Hospital Urology Clinic, the only county-run urology clinic, is reducing operations due to budget cuts."

As you can see from the above, the poor may suffer more as they compete for funding/services under universal health care. This is one very good reason we shouldn't rush into a sweeping reform without carefully considering the impact on the county and city level.

I think the reason that France, Germany and England could transition to universal care with relative ease is that after WWII they almost nothing left. They rebuilt from the ground up, we're deconstructing from the top down. We better do it right.

b, it is not enough to "do something" if the something that we do will not have the results that we want. It is not more moral to "do something" for the sake of "doing something" so that you can tell yourself that at least, even if nothing got better, you didn't sit around and "do nothing."

Most people agree that changes need to be made, that parts of what we have now are not the best plan, not the best system.

Some people think that we can make huge changes without risk or unintended consequences, that we can't break the best parts of health care in the US if we don't intend to break it, that what is strong and innovative will continue but just this little thing, those few uninsured, will be gathered up and cared for.

We've been reassured and promised that certain things WILL NOT HAPPEN. Costs won't go up. Elderly will not be advised to die with dignity unless it is their very own idea. Private insurance will remain legal, available, and diverse. We WILL be able to keep our present insurance if we like it.

All of these things are not true.

I'm still waiting, actually, for one of the commenters here who claimed he had a small business and insured his employees at costs he had trouble dealing with if Obama's promise that his employees would be able to keep their present insurance if they preferred to keep it.

I know the answer.

It will make economic sense to change to the government option and his employees WILL NOT have the option of keeping their present insurance.

Insurance companies having certain treatments or elective procedures that they will not cover, or policies that only cover catastrophic care are not being compared to an alternate rainbows and unicorns system where there is no rationing and never any denied treatments.

Obama said right out clear as day that treatments that aren't likely to work will be denied.

"In 2002, the Romanow report stated that diagnostic imaging wait times were increasing at a high rate and patients were consulting newly formed private MRI clinics. Recently, the Federal Advisor on Wait Times released his final report (Postl 2006) highlighting the continuing issue of increasing wait times despite the injection of resources following the 2004 First Ministers' meeting. Indeed, the issue of wait times, the report concludes, cannot be determined independently of the rest of the healthcare system. Wait times for high-technology services continue to be lengthy despite enhanced federal funding (Romanow 2002; Esmail and Walker 2002). Long waits for MRI procedures have garnered particular attention because of the technology's broad clinical indications (Keller 2005; CIHI 2004; Ehman 2004a). Since MRIs are critically important in diagnosing many conditions that require superior image resolution, the evidence that Canada has fewer MRI machines per capita than most developed countries is a potential concern for the public because of slower diagnostic time and reduced ability to monitor disease progression (Keller 2005; CIHI 2004; Ehman 2004a)." (my bolding)

Perhaps we will have a Wait Time Czar.

"A University of Toronto study found that consumers get an MRI in a few days if they pay out of their own pockets at a private clinic. Waits in the public system can be 13 weeks or longer.

The study, titled How Busy Are Private MRI Centres in Canada? and published in the journal Healthcare Policy, found only 17 privately owned clinics said they let people pay out-of-pocket for scans.

Six provinces have privately owned clinics, but only four -- B.C., Alberta, Nova Scotia and Quebec -- have clinics that accept private payments.

Under the Canada Health Act and provincial statutes, patients are not supposed to pay for medically necessary services unless a third-party insurer such as Blue Cross or WorkSafeBC pays on their behalf. But most patient-pays scans are done under the radar."

The breast cancer link was very interesting, BJM, and the discussion about how to go outside the government health care system of Canada or Australia mirror experiences my husband had with the military health care system here in the US.

I don't know how many airmen actually did it, but there was a whole lot of talk about going "off-base" to get medical imaging done in order to get the ball rolling on the "free" care provided by the military.

My husband didn't end up paying for his imaging "out of pocket" because we traveled to a place far enough from any military medical facility (my parents house!) to bill the emergency doctor's visit the same way insurance would be billed.

The military was generally very good when it came to medical care, and I never got the idea that the issue was wait times... it was more having doctors that didn't think you needed a CAT scan or MRI for your sore back and airmen who thought they *did* and no option but somehow finding the cash to pay to see a private doctor.

The civilian CAT/MRI we obtained showed that my husband had three herniated disks in his lower back. He'd had them for at least a year.

Insurance companies having certain treatments or elective procedures that they will not cover, or policies that only cover catastrophic care are not being, compared to an alternate rainbows and unicorns system where there is no rationing and never any denied treatments.

I'm sorry by your use of hyperbole makes your point unclear.

I didn't think it necessary to identify that I am talking about rationing non-elective treatment. The point I am failing to make is that people are clearly worried, under a public option, necessary treatment will be rationed or denied. However there are thousands of stories of people who have lifesaving treatment denied by private insurers.

I'm not getting why people who are afraid of rationing can't see that it exists with the private option.

I'd take exception to the assumption that in one system rationing only applies to elective procedures and in the other system life saving treatment is denied.

Other than that, yes, rationing is going to happen by one name or another in one form or another simply because medical knowledge is bounding forward so that there is always more bigger more fabulous ways to save or extend or make your life more comfortable. Demand will always exceed supply.

Which is actually a feature, not a bug.

"I'm not getting why people who are afraid of rationing can't see that it exists with the private option."

It exists, yes, but it's not as frightening because there really is more flexibility so it doesn't *feel* as implacable. Even if you feel a bit stuck where you are, at least it's not the whole weight of government keeping you there.

More flexibility would be better. In past years that's what people have pushed for, to make it easier to see different doctors, insure the right to second opinions... things like that.

Obama has assured us again and again that multiple options will remain available, that there will be more competition instead of less, but I can't see how. A promise that anyone who prefers their current insurance can keep it is an outright lie if your employer drops the insurance you prefer. Simply saying it over again does not reassure anyone but the most gullible that their fear that the public option will replace other options and limit flexibility and choice is unfounded... even if it is not demanded by the legislation and even if it happens slowly.

There are definitely many ways to improve the way we regulate and use private insurance and most certainly are ways to build on the strengths of free-choice and personal, individual control over your own health care.